Skip to main content
SpringerLink
Log in
Book cover

Noninvasive Vascular Diagnosis pp 711–723Cite as

The Role of Color Duplex Ultrasound in Patients with Abdominal Aortic Aneurysms and Peripheral Aneurysms

  • 2148 Accesses

Abstract

Ultrasound diagnosis has been used for abdominal aortic aneurysms and peripheral aneurysms for many years, yet the nuances required for proper interrogation and interpretation can be quite difficult. While CT and ultrasound have been used interchangeably, it is become clear that the measurements derived are not necessarily equivalent. Newer ultrasound technology allows CT and ultrasound images to be fused for correlation of differences between these modalities. This fusion technology may allow differences between the imaging techniques to be resolved during the real-time ultrasound evaluation.

Major trials such as the UK Small Aneurysm Trial utilized ultrasound as the primary modality for imaging abdominal aortic aneurysms that did not yet require intervention. Once an aneurysm reaches the size appropriate for intervention, then CT scans provide an objective data set that can be used in a number of ways for procedure planning. The complementary use of CT and ultrasound for the management of abdominal aortic aneurysms is critical to the proper management of these patients. By using ultrasound, radiation and intravenous contrast can be avoided until such time as intervention planning becomes necessary.

In the periphery ultrasound has always had a preeminent role in the diagnosis and management of extremity aneurysms in particular. Both femoral and popliteal aneurysms can be followed and management planned based on ultrasound alone. While ultrasound in the abdomen may be limited by bowel gas and patient body habitus, in the periphery these issues are rarely a concern. Overall, ultrasound and CT imaging are complementary modalities that allow both deep imaging and noninvasive surveillance depending on the clinical scenario.

Keywords

  • Ultrasound diagnosis of aneurysms
  • Abdominal aortic aneurysm
  • Popliteal aneurysms
  • CT scans for AAA diagnosis
  • Femoral aneurysms
  • CT versus ultrasound for AAA diagnosis

This is a preview of subscription content, access via your institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Raman KG, et al. Color-flow duplex ultrasound scan versus computed tomographic scan in the surveillance of endovascular aneurysm repair. J Vasc Surg. 2003;38(4):645–51.

    CrossRef  PubMed  Google Scholar 

  2. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991;5(6):491–9.

    CrossRef  CAS  PubMed  Google Scholar 

  3. Sato DT, et al. Endoleak after aortic stent graft repair: diagnosis by color duplex ultrasound scan versus computed tomography scan. J Vasc Surg. 1998;28(4):657–63.

    CrossRef  CAS  PubMed  Google Scholar 

  4. Heilberger P, et al. Postoperative color flow duplex scanning in aortic endografting. J Endovasc Surg. 1997;4(3):262–71.

    CrossRef  CAS  PubMed  Google Scholar 

  5. Parent FN, et al. The incidence and natural history of type I and II endoleak: a 5-year follow-up assessment with color duplex ultrasound scan. J Vasc Surg. 2002;35(3):474–81.

    CrossRef  PubMed  Google Scholar 

  6. Fillinger MF. Postoperative imaging after endovascular AAA repair. Semin Vasc Surg. 1999;12(4):327–38.

    CAS  PubMed  Google Scholar 

  7. Teodorescu VJ, Morrissey NJ, Olin JW. Duplex ultrasonography and its impact on providing endograft surveillance. Mt Sinai J Med. 2003;70(6):364–6.

    PubMed  Google Scholar 

  8. Sprouse LR 2nd, et al. Is ultrasound more accurate than axial computed tomography for determination of maximal abdominal aortic aneurysm diameter? Eur J Vasc Endovasc Surg. 2004;28(1):28–35.

    CrossRef  PubMed  Google Scholar 

  9. Collins JT, Boros MJ, Combs K. Ultrasound surveillance of endovascular aneurysm repair: a safe modality versus computed tomography. Ann Vasc Surg. 2007;21(6):671–5.

    CrossRef  PubMed  Google Scholar 

  10. Chaer RA, et al. Duplex ultrasound as the sole long-term surveillance method post-endovascular aneurysm repair: a safe alternative for stable aneurysms. J Vasc Surg. 2009;49(4):845–9. discussion 849–50.

    CrossRef  PubMed  Google Scholar 

  11. Beeman BR, et al. Duplex ultrasound factors predicting persistent type II endoleak and increasing AAA sac diameter after EVAR. J Vasc Surg. 2010;52(5):1147–52.

    CrossRef  PubMed  Google Scholar 

  12. Gillum RF. Epidemiology of aortic aneurysm in the United States. J Clin Epidemiol. 1995;48(11):1289–98.

    CrossRef  CAS  PubMed  Google Scholar 

  13. Dubost C, Allary M, Oeconomos N. Resection of an aneurysm of the abdominal aorta: reestablishment of the continuity by a preserved human arterial graft, with result after five months. AMA Arch Surg. 1952;64(3):405–8.

    CrossRef  CAS  PubMed  Google Scholar 

  14. Szilagyi DE, et al. Contribution of abdominal aortic aneurysmectomy to prolongation of life. Ann Surg. 1966;164(4):678–99.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  15. Estes JE Jr. Abdominal aortic aneurysm; a study of one hundred and two cases. Circulation. 1950;2(2):258–64.

    CrossRef  PubMed  Google Scholar 

  16. Fink HA, et al. The accuracy of physical examination to detect abdominal aortic aneurysm. Arch Intern Med. 2000;160(6):833–6.

    CrossRef  CAS  PubMed  Google Scholar 

  17. Demos NJ. Severe vascular impairment of the left half of the colon. Int Abstr Surg. 1963;117:205–12.

    CAS  PubMed  Google Scholar 

  18. Brown LC, Powell JT. Risk factors for aneurysm rupture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants. Ann Surg. 1999;230(3):289–96. discussion 296–7.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  19. Palombo D, et al. Changes in the proximal neck of abdominal aortic aneurysms early after endovascular treatment. Ann Vasc Surg. 2003;17(4):408–10.

    CrossRef  PubMed  Google Scholar 

  20. Thurnher S, Cejna M. Imaging of aortic stent-grafts and endoleaks. Radiol Clin North Am. 2002;40(4):799–833.

    CrossRef  PubMed  Google Scholar 

  21. Donald I, Brown TG. Demonstration of tissue interfaces within the body by ultrasonic echo sounding. Br J Radiol. 1961;34:539–46.

    CrossRef  CAS  PubMed  Google Scholar 

  22. Maloney JD, et al. Ultrasound evaluation of abdominal aortic aneurysms. Circulation. 1977;56(3 Suppl):II80–5.

    CAS  PubMed  Google Scholar 

  23. Hertzer NR, Beven EG. Ultrasound aortic measurement and elective aneurysmectomy. JAMA. 1978;240(18):1966–8.

    CrossRef  CAS  PubMed  Google Scholar 

  24. Ommaya AK. Computerized axial tomography of the head: the EMI-scanner, a new device for direct examination of the brain “in vivo”. Special article. Surg Neurol. 1973;1(4):217–22.

    CAS  PubMed  Google Scholar 

  25. Paul JF, Abada HT. Strategies for reduction of radiation dose in cardiac multislice CT. Eur Radiol. 2007;17(8):2028–37.

    CrossRef  PubMed  Google Scholar 

  26. Simoni G, et al. Helical CT for the study of abdominal aortic aneurysms in patients undergoing conventional surgical repair. Eur J Vasc Endovasc Surg. 1996;12(3):354–8.

    CrossRef  CAS  PubMed  Google Scholar 

  27. Aziz I, et al. Accuracy of three-dimensional simulation in the sizing of aortic endoluminal devices. Ann Vasc Surg. 2003;17(2):129–36.

    CrossRef  PubMed  Google Scholar 

  28. Sprouse LR 2nd, et al. Is three-dimensional computed tomography reconstruction justified before endovascular aortic aneurysm repair? J Vasc Surg. 2004;40(3):443–7.

    CrossRef  PubMed  Google Scholar 

  29. Mower WR, Baraff LJ, Sneyd J. Stress distributions in vascular aneurysms: factors affecting risk of aneurysm rupture. J Surg Res. 1993;55(2):155–61.

    CrossRef  CAS  PubMed  Google Scholar 

  30. Stringfellow MM, Lawrence PF, Stringfellow RG. The influence of aorta-aneurysm geometry upon stress in the aneurysm wall. J Surg Res. 1987;42(4):425–33.

    CrossRef  CAS  PubMed  Google Scholar 

  31. Bihari P, et al. Strain measurement of abdominal aortic aneurysm with real-time 3D ultrasound speckle tracking. Eur J Vasc Endovasc Surg. 2013;45(4):315–23.

    CrossRef  CAS  PubMed  Google Scholar 

  32. Derwich W, et al. High resolution strain analysis comparing aorta and abdominal aortic aneurysm with real time three dimensional speckle tracking ultrasound. Eur J Vasc Endovasc Surg. 2016;51(2):187–93.

    CrossRef  CAS  PubMed  Google Scholar 

  33. Favreau JT, et al. Murine ultrasound imaging for circumferential strain analyses in the angiotensin II abdominal aortic aneurysm model. J Vasc Surg. 2012;56(2):462–9.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  34. McBride OM, et al. Positron emission tomography and magnetic resonance imaging of cellular inflammation in patients with abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2016;51:518–26.

    CrossRef  CAS  PubMed  PubMed Central  Google Scholar 

  35. Morbelli S, et al. Systemic vascular inflammation in abdominal aortic aneurysm patients: a contrast-enhanced PET/CT study. Q J Nucl Med Mol Imaging. 2014;58(3):299–309.

    CAS  PubMed  Google Scholar 

  36. Gouliamos AD, et al. Screening for abdominal aortic aneurysms during routine lumbar CT scan: modification of the standard technique. Clin Imaging. 2004;28(5):353–5.

    CrossRef  PubMed  Google Scholar 

  37. Lederle FA, et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA. 2009;302(14):1535–42.

    CrossRef  CAS  PubMed  Google Scholar 

  38. Sprouse LR 2nd, et al. Comparison of abdominal aortic aneurysm diameter measurements obtained with ultrasound and computed tomography: Is there a difference? J Vasc Surg. 2003;38(3):466–71. discussion 471–2.

    CrossRef  PubMed  Google Scholar 

  39. Truijers M, et al. Endovascular aneurysm repair: state-of-art imaging techniques for preoperative planning and surveillance. J Cardiovasc Surg (Torino). 2009;50(4):423–38.

    CAS  Google Scholar 

  40. Pages S, et al. Comparison of color duplex ultrasound and computed tomography scan for surveillance after aortic endografting. Ann Vasc Surg. 2001;15(2):155–62.

    CrossRef  CAS  PubMed  Google Scholar 

  41. Nagre SB, et al. Evaluating outcomes of endoleak discrepancies between computed tomography scan and ultrasound imaging after endovascular abdominal aneurysm repair. Ann Vasc Surg. 2011;25(1):94–100.

    CrossRef  PubMed  Google Scholar 

  42. Singh K, et al. The difference between ultrasound and computed tomography (CT) measurements of aortic diameter increases with aortic diameter: analysis of axial images of abdominal aortic and common iliac artery diameter in normal and aneurysmal aortas. The Tromso Study, 1994-1995. Eur J Vasc Endovasc Surg. 2004;28(2):158–67.

    CrossRef  CAS  PubMed  Google Scholar 

  43. Henao EA, et al. Contrast-enhanced Duplex surveillance after endovascular abdominal aortic aneurysm repair: improved efficacy using a continuous infusion technique. J Vasc Surg. 2006;43(2):259–64. discussion 264.

    CrossRef  PubMed  Google Scholar 

  44. Cantisani V, et al. Prospective comparative analysis of colour-Doppler ultrasound, contrast-enhanced ultrasound, computed tomography and magnetic resonance in detecting endoleak after endovascular abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg. 2011;41(2):186–92.

    CrossRef  CAS  PubMed  Google Scholar 

  45. White RA, et al. Intravascular ultrasound: the ultimate tool for abdominal aortic aneurysm assessment and endovascular graft delivery. J Endovasc Surg. 1997;4(1):45–55.

    CrossRef  CAS  PubMed  Google Scholar 

  46. Ten Bosch JA, et al. Contrast-enhanced ultrasound versus computed tomographic angiography for surveillance of endovascular abdominal aortic aneurysm repair. J Vasc Interv Radiol. 2010;21(5):638–43.

    CrossRef  PubMed  Google Scholar 

  47. Sommer WH, et al. Comparison of time-resolved CT-angiography, contrast-enhanced ultrasound and digital subtraction angiography in a patient with a small type II endoleak after endovascular aneurysm repair. Clin Hemorheol Microcirc. 2010;45(1):19–25.

    PubMed  Google Scholar 

  48. Mirza TA, et al. Duplex ultrasound and contrast-enhanced ultrasound versus computed tomography for the detection of endoleak after EVAR: systematic review and bivariate meta-analysis. Eur J Vasc Endovasc Surg. 2010;39(4):418–28.

    CrossRef  CAS  PubMed  Google Scholar 

  49. Clevert DA, et al. Imaging of aortic lesions with color coded duplex sonography and contrast-enhanced ultrasound versus multislice computed tomography (MS-CT) angiography. Clin Hemorheol Microcirc. 2008;40(4):267–79.

    PubMed  Google Scholar 

  50. Canbaz S, et al. Bilateral popliteal artery aneurysms with rupture and pseudoaneurysm formation on the left. Yonsei Med J. 2003;44(1):159–62.

    CrossRef  PubMed  Google Scholar 

  51. Mc HJ. Spontaneous rupture of bilateral popliteal aneurysms. Ann Surg. 1951;133(1):131–4.

    CrossRef  Google Scholar 

  52. Anton GE, et al. Surgical management of popliteal aneurysms. Trends in presentation, treatment, and results from 1952 to 1984. J Vasc Surg. 1986;3(1):125–34.

    CrossRef  CAS  PubMed  Google Scholar 

  53. Lilly MP, et al. The effect of distal arterial anatomy on the success of popliteal aneurysm repair. J Vasc Surg. 1988;7(5):653–60.

    CrossRef  CAS  PubMed  Google Scholar 

  54. Whitehouse WM Jr, et al. Limb-threatening potential of arteriosclerotic popliteal artery aneurysms. Surgery. 1983;93(5):694–9.

    PubMed  Google Scholar 

  55. Dawson I, Sie RB, van Bockel JH. Atherosclerotic popliteal aneurysm. Br J Surg. 1997;84(3):293–9.

    CrossRef  CAS  PubMed  Google Scholar 

  56. Debasso R, et al. The popliteal artery, an unusual muscular artery with wall properties similar to the aorta: implications for susceptibility to aneurysm formation? J Vasc Surg. 2004;39(4):836–42.

    CrossRef  CAS  PubMed  Google Scholar 

  57. Wain RA, Hines G. A contemporary review of popliteal artery aneurysms. Cardiol Rev. 2007;15(2):102–7.

    CrossRef  PubMed  Google Scholar 

  58. Szilagyi DE, Schwartz RL, Reddy DJ. Popliteal arterial aneurysms. Their natural history and management. Arch Surg. 1981;116(5):724–8.

    CrossRef  CAS  PubMed  Google Scholar 

  59. Inahara T, Toledo AC. Complications and treatment of popliteal aneurysms. Surgery. 1978;84(6):775–83.

    CAS  PubMed  Google Scholar 

  60. Lowell RC, et al. Popliteal artery aneurysms: the risk of nonoperative management. Ann Vasc Surg. 1994;8(1):14–23.

    CrossRef  CAS  PubMed  Google Scholar 

  61. Silver TM, et al. Gray scale ultrasound evaluation of popliteal artery aneurysms. AJR Am J Roentgenol. 1977;129(6):1003–6.

    CrossRef  CAS  PubMed  Google Scholar 

  62. Ravn H, Bjorck M. Popliteal artery aneurysm: epidemiology and modern management. Acta Chir Belg. 2009;109(1):13–9.

    CrossRef  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Tennessee Health Science Center, 910 Madison Ave., 2nd Floor, Memphis, TN, 38163, USA

    Shaun M. Stickley MD

  2. Surgery, Vascular Surgery, College of Medicine, University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0513, Cincinnati, OH, 45267-0513, USA

    George H. Meier III MD, RVT, FACS, FSVS

Authors
  1. Shaun M. Stickley MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. George H. Meier III MD, RVT, FACS, FSVS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to George H. Meier III MD, RVT, FACS, FSVS .

Editor information

Editors and Affiliations

  1. Charleston, West Virginia, USA

    Prof. Ali F. AbuRahma

Review Questions

Review Questions

  1. 1.

    When measuring the AAA size:

    1. a.

      B-mode ultrasound is within 1 cm of the true aortic diameter in 75% of patients.

    2. b.

      B-mode ultrasound is within 0.5 cm of the true aortic diameter in 75% of patients.

    3. c.

      B-mode ultrasound is within 0.2 cm of the true aortic diameter in 75% of patients.

    4. d.

      B-mode ultrasound is within 0.5 cm of the true aortic diameter in 100% of patients.

  2. 2.

    When planning EVAR:

    1. a.

      CT scanning is the primary method for endograft sizing and determining aortic neck anatomy.

    2. b.

      Duplex ultrasound is the primary method for endograft sizing and determining aortic neck anatomy.

    3. c.

      Both CT scanning and duplex ultrasound are equally effective in endovascular sizing and determining aortic neck anatomy.

    4. d.

      All of the above.

  3. 3.

    When comparing the accuracy of CT scanning and duplex ultrasound measurements in determining the size of AAA:

    1. a.

      CT scan measurements are usually larger than ultrasound imaging measurements.

    2. b.

      CT scan measurements are usually smaller than ultrasound imaging measurements.

    3. c.

      CT scan measurements and ultrasound imaging measurements are equivalent.

    4. d.

      None of the above.

Answer Key

  1. 1.

    b

  2. 2.

    a

  3. 3.

    a

Rights and permissions

Reprints and Permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Stickley, S.M., Meier, G.H. (2017). The Role of Color Duplex Ultrasound in Patients with Abdominal Aortic Aneurysms and Peripheral Aneurysms. In: AbuRahma, A. (eds) Noninvasive Vascular Diagnosis. Springer, Cham. https://doi.org/10.1007/978-3-319-54760-2_53

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-54760-2_53

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-54758-9

  • Online ISBN: 978-3-319-54760-2

  • eBook Packages: MedicineMedicine (R0)

search

Navigation